A REVIEW OF NINETYTHREE TRANSPELVIC GUNSHOT WOUNDS

Abstract

We reviewed ninety-three civilian transpelvic gunshot wounds from 1998 to date. The patients were all recruited through our Trauma Unit. The first sixty were seen on a referral basis, yet for the subsequent patients we were informed on admission. Based on our earlier findings we promoted bullet tract washout, bullet removal when passed through hollow viscus, rectal stump washout and early removal of juxta-articular bullets. We review the nature of associated injuries and outcomes in relation to osteitis, osteoarthritis, nerve injuries and vascular injuries.

Fifty-seven patients had an entry wound in the buttock. This is associated with a high incidence of sciatic nerve damage (14%), extra peritoneal rectal injury (21%), juxta-articular bullets (73%) and osteitis (12%). There were fifty patients with hollow viscus injuries in various combinations. Thirteen patients overall developed osteitis (14%), of these twelve had hollow viscus injuries. Of these extra-peritoneal rectal injuries carry the highest proportion of osteitis (33%) as a complication, followed by colonic injuries (25%) and bladder (21%). Small bowel injuries (29) were not associated with any osteitis.

Peri and intra-articular injuries were grouped together totalling fifty-nine. Seven of these developed osteitis, leading to secondary osteoarthritis in all. The sciatic nerve was damaged in nine patients, and only three recovered fully. There were two femoral nerve injuries with no significant sequelae. In extra-peritoneal rectal injuries those who had early rectal stump wash-out (5/12) did not develop osteitis and yet of those not washed (5/12) three developed osteitis (60%). Tract washout has similar results. Of bullets that passed through a hollow viscus and were removed late 45% (8/18) were infected.

Our preliminary results suggest that all missile tracts should be washed out and debrided, that all bullets traversing a hollow viscus should be removed, that all peri-articular bullets be removed, and that the rectal stump be washed out in extra-peritoneal rectal injuries.